Director-Premium Billing and Member Enrollment

Director Premium Billing and Member Enrollment (Director II)

Work type: Full Time

About the Role

We are seeking a strategic thinker with a proven track record of leading high-performing teams to establish and manage the Enrollment and Billing function related to Health Insurance Exchange/Marketplace/Covered California product operations. This role is critical in building and executing seamless enrollment, accurate billing, and regulatory compliance for product line expansion.

As Director, you will define and scale your team, create a roadmap, implement operational processes, and close gaps in people, process, and technology to support enrollment and billing capabilities for the Covered California line of business. You will play a key role in strengthening revenue recognition processes, supporting managed care contract modeling, and maintaining reimbursement estimation tools used for forecasting and financial planning.

Responsibilities

Leadership Functions (45%)

• Cultivate and promote a mission-driven culture of high-quality performance with a member focus on customer service, consistency, dignity, and accountability.
• Direct, hire, and train department managers and staff; set monthly or quarterly goals.
• Serve as the key advisor for executive leadership on strategic decisions impacting Enrollment and Billing operations.
• Develop and execute a 12–18-month roadmap to operationalize Enrollment and Billing capabilities for Covered California, integrating with existing workflows and configuring systems to support new processes.
• Build and lead the Enrollment and Billing function, including recruiting, coaching, and retaining staff, establishing governance structures, and collaborating cross-functionally.
• Oversee timely and accurate completion of Covered California enrollment processes, including ingestion and processing of 834 enrollment files, plan changes, cancellations, and grace-period management.

Program Oversight (50%)

• Implement and oversee end-to-end premium billing capability, including invoice generation, member payments, financial reconciliation (including subsidies), and refunds.
• Reconcile membership and premium data with Covered California and internal systems to ensure regulatory compliance and data accuracy.
• Manage enrollment and billing processing and reconciliation for off-exchange populations.
• Oversee integration and management of enrollment and billing capabilities handled by third-party vendors and delegated networks.
• Lead vendor and technology selection for vended capabilities and oversee implementation and integration with organizational processes and technologies.
• Partner with IT and vendor teams to configure core admin systems, oversee system/data integrations, and optimize premium billing capabilities.
• Develop and manage the annual departmental budget.

Other (5%)

• Complete additional projects and duties as assigned.

Minimum Qualifications

• Bachelor’s degree in business, health administration, finance, or related field (Master’s preferred).
• 7 years in health-plan operations, with at least 5 years in health insurance exchange/marketplace and/or commercial Individual and Family Plan (IFP) enrollment and billing.
• 3 years of progressive management/leadership experience.
• Must have Covered California experience.

Preferred Qualifications

• Prior experience at a health plan leading enrollment and billing functions for exchange or commercial products.
• Specific experience with Covered California.

Skills & Abilities

• Strong leadership and relationship-building skills across diverse teams and stakeholders.
• Ability to work independently, exercise sound judgment, and communicate clearly.
• Analytical, problem-solving, and project management skills in fast-paced environments.
• Ability to manage multiple projects, motivate teams, and identify opportunities for collaboration.
• Proficiency in Microsoft Office and job-specific applications/systems.

Compensation & Benefits

• Comprehensive benefits package including pension program, retirement plans, generous PTO, wellness programs, tuition reimbursement, professional development, flexible scheduling, and career growth opportunities.

Work Environment

• Primarily indoors and sedentary, with variable work hours and occasional travel.
• May include clinical or community settings depending on assignment.
• Noise levels range from moderate to loud depending on location.